Long-term effectiveness and safety of anti-TNF in pediatric-onset inflammatory bowel diseases: A population-based study
In: ISSN: 1590-8658 ; Digestive and Liver Disease ; https://u-picardie.hal.science/hal-04088937 ; Digestive and Liver Disease, 2023, ⟨10.1016/j.dld.2023.04.017⟩, 2023
academicJournal
Zugriff:
International audience ; Background: Anti-TNF agents are the first biologic treatment option in inflammatory bowel disease (IBD). The long-term effectiveness of this strategy at the population level is poorly known, particularly in pediatric-onset IBD.Methods: All patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) before the age of 17 between 1988 and 2011 in the EPIMAD population-based registry were followed retrospectively until 2013. Among patients treated with anti-TNF, the cumulative probabilities of anti-TNF failure defined by primary failure, loss of response (LOR) or intolerance were evaluated. Factors associated with anti-TNF failure were investigated by a Cox model.Results: Among a total of 1,007 patients with CD and 337 patients with UC, respectively 481 (48%) and 81 (24%) were treated with anti-TNF. Median age at anti-TNF initiation was 17.4 years (IQR, 15.1-20.9). Median duration of anti-TNF therapy was 20.4 months (IQR, 6.0-59.9). In CD, the probability of failure of 1st line anti-TNF at 1, 3 and 5 years was respectively 30.7%, 51.3% and 61.9% for infliximab and 25.9%, 49.3% and 57.7% for adalimumab (p = 0.740). In UC, the probability of failure of 1st line anti-TNF therapy was respectively 38.4%, 52.3% and 72.7% for infliximab and 12.5% for these 3 timepoints for adalimumab (p = 0.091). The risk of failure was maximal in the first year of treatment and LOR was the main reason for discontinuation. Female gender was associated with LOR (HR, 1.48; 95%CI 1.02-2.14) and with anti-TNF withdrawal for intolerance in CD (HR, 2.31; 95%CI 1.30-4.11) and disease duration (≥ 2 y vs. < 2 y) was associated with LOR in UC (HR, 0.37; 95%CI 0.15-0.94) in multivariate analysis. Sixty-three (13.5%) patients observed adverse events leading to termination of treatment (p = 0.57). No death, cancer or tuberculosis was observed while the patients were under anti-TNF treatment.Conclusion: In a population-based study of pediatric-onset IBD, about 60% in CD and 70% in UC experienced anti-TNF failure ...
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Long-term effectiveness and safety of anti-TNF in pediatric-onset inflammatory bowel diseases: A population-based study
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| Autor/in / Beteiligte Person: | Fumery, Mathurin ; Dupont, Claire ; Ley, Delphine ; Savoye, Guillaume ; Bertrand, Valérie ; Guillon, Nathalie ; Wils, Pauline ; Gower-Rousseau, Corinne ; Sarter, Helene ; Turck, Dominique ; Leroyer, Ariane ; Périnatalité et Risques Toxiques - UMR INERIS_I 1 (PERITOX) ; Institut National de l'Environnement Industriel et des Risques (INERIS)-Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie ; Amiens-Picardie, CHU ; Laboratoire Traitement du Signal et de l'Image (LTSI) ; Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM) ; Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Ponchaillou ; Institute for Translational Research in Inflammation - U 1286 (INFINITE (Ex-Liric)) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille) ; Nutrition, Inflammation et axe Microbiote-Intestin-Cerveau (ADEN) ; Université de Rouen Normandie (UNIROUEN) ; Normandie Université (NU)-Normandie Université (NU)-Institute for Research and Innovation in Biomedicine (IRIB) ; Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Rouen Normandie (UNIROUEN) ; Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM) ; Institute for Research and Innovation in Biomedicine (IRIB) ; Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS) ; UNIROUEN - UFR Santé (UNIROUEN UFR Santé) ; Normandie Université (NU)-Normandie Université (NU) ; Service d'Hépato-Gastroentérologie CHU Rouen ; Hôpital Charles Nicolle Rouen ; Rouen, CHU ; Normandie Université (NU)-Normandie Université (NU)-CHU Rouen ; Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN) ; Normandie Université (NU) ; Groupe Hospitalier du Havre Hôpital Jacques Monod (MONTIVILLIERS) (GHH) ; Service d'Epidémiologie et de Santé Publique Lille ; Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille) |
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| Zeitschrift: | ISSN: 1590-8658 ; Digestive and Liver Disease ; https://u-picardie.hal.science/hal-04088937 ; Digestive and Liver Disease, 2023, ⟨10.1016/j.dld.2023.04.017⟩, 2023 |
| Veröffentlichung: | HAL CCSD ; Elsevier, 2023 |
| Medientyp: | academicJournal |
| DOI: | 10.1016/j.dld.2023.04.017 |
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